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Published ahead of print on October 2, 2003, doi:10.1164/rccm.200303-455OC
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American Journal of Respiratory and Critical Care Medicine Vol 168. pp. 1457-1461, (2003)
© 2003 American Thoracic Society

The Long-term Psychological Effects of Daily Sedative Interruption on Critically Ill Patients

John P. Kress, Brian Gehlbach, Maureen Lacy, Neil Pliskin, Anne S. Pohlman and Jesse B. Hall

Departments of Medicine and Psychiatry, University of Chicago, Chicago, Illinois

Correspondence and requests for reprints should be addressed to John P. Kress, M.D., Section of Pulmonary and Critical Care Medicine, MC 6026, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637. E-mail: jkress{at}medicine.bsd.uchicago.edu

Critically ill patients often receive sedatives, which may delay liberation from mechanical ventilation and intensive care unit discharge. Daily interruption of sedatives alleviates these problems, but the impact of this practice on long-term psychological outcomes is unknown. We compared psychological outcomes of intensive care unit patients undergoing daily sedative interruption (intervention) with those without this protocol (control). Assessments using (1) the Revised Impact of Event Scale (evaluates signs of posttraumatic stress disorder [PTSD]), (2) the Medical Outcomes Study 36 item short-form health survey, (3) the State-Trait Anxiety Inventory, (4) the Beck Depression Inventory-2, (5) and the Psychosocial Adjustment to Illness score (overall quality of adjustment to current or residual effects of illness) were done by blinded observers. The intervention group had a better total Impact of Events score (11.2 vs. 27.3, p = 0.02), a trend toward a lower incidence of PTSD (0% vs. 32%, p = 0.06), and a trend toward a better total Psychosocial Adjustment to Illness score (46.8 vs. 54.3, p = 0.08). We conclude that daily sedative interruption does not result in adverse psychological outcomes, reduces symptoms of PTSD, and may be associated with reductions in posttraumatic stress disorder.

Key Words: sedatives • ventilation, mechanical • neuropsychological tests • outcomes research




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